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睑板腺又称麦氏腺,是全身最大的皮脂腺,位于上、下睑板之中,其导管终末端开口于睑缘的皮肤与黏膜交界处,主要功能为分泌睑脂。当瞬目时,眼轮匝肌和Rioland肌收缩,挤压睑板腺,驱使睑脂排出。随着开睑,聚集在睑缘处的睑脂被拉伸为膜状,形成泪膜最表面的脂质层,在保持泪膜稳定、延缓泪膜水分蒸发、维持泪液渗透压、防止睑缘泪液溢出、润滑眼睑与眼球接触面等方面发挥重要作用[1]。睑板腺功能障碍(meibomian gland dysfunction,MGD)是一种以睑板腺导管阻塞,睑酯分泌障碍,以及睑酯质和/或量异常为主要特征的慢性、弥漫性病变,常引起泪膜异常和眼表的炎症反应[2]。MGD病人均有不同程度的眼部刺激症状,表现为干涩、畏光、痒、异物感、烧灼感及眨眼障碍等,严重者可出现角膜损伤,出现视力波动、视物模糊等症状。眼睑检查可见睑板腺开口突出、睑缘不规则、局部充血等体征,挤压腺体可见黄白色黏稠分泌物溢出。MGD临床治疗大多采用人工泪液和抗生素眼药水点眼来改善症状,但长期使用药物可能会在一定程度上损伤眼表上皮,且很难从根本上缓解睑板腺阻塞引发的系列症状,治疗效果不太理想。本研究拟评估中药熏蒸联合睑板腺按摩在MGD治疗中的应用价值,以期为提升MGD的治疗水平提供新的参考和策略。
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治疗前2组OSDI分值、睑板腺功能异常评分、TBUT、SIT及CFS积分值差异均无统计学意义(P>0.05);治疗4周后观察组OSDI分值、睑板腺功能异常评分、CFS积分均低于对照组, TBUT和SIT值均高于对照组(P < 0.01)(见表 1)。
分组 n OSDI分值 睑板腺功能异常评分 TBUT值/s SIT值/(mm/5 min) CFS积分值 治疗前 观察组 33 48.59±10.45 3.31±0.44 2.72±0.81 2.62±0.74 9.04±1.62 对照组 33 47.89±11.24 3.22±0.39 2.87±0.91 2.79±0.82 8.86±1.57 t — 0.26 0.88 0.71 0.88 0.46 P — >0.05 >0.05 >0.05 >0.05 >0.05 治疗4周后 观察组 33 15.38±3.78 1.14±0.79 8.26±1.09 6.78±1.42 2.34±0.87 对照组 33 25.68±7.14 2.64±0.86 4.73±1.44 3.86±1.03 4.65±1.12 t — 7.32* 7.38 11.23 9.56 0.36 P — <0.01 <0.01 <0.01 <0.01 <0.01 *示t′检验 表 1 2组各项评估指标的比较(x±s)
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治疗4周后观察组临床疗效好于对照组(P<0.01)(见表 2)。
分组 n 显效 有效 无效 总有效 有效率/% uc P 观察组 33 14 16 3 30 90.9 2.66 < 0.01 对照组 33 8 11 14 19 57.6 合计 66 22 27 17 49 74.2 表 2 治疗4周后2组临床疗效比较
中药熏蒸联合局部按摩治疗睑板腺功能障碍的效果分析
Effect of herbal fumigation combined with local massage in the treatment of meibomian gland dysfunction
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摘要:
目的评估中药熏蒸联合局部按摩治疗睑板腺功能障碍(MGD)的临床疗效。 方法选取MGD病人66例(132眼),随机分为观察组和对照组,每组33例(66眼)。对照组给予人工泪液、抗炎滴眼液治疗为主,对于疑似感染或三级以上MGD病人另外加服阿奇霉素;观察组在此基础上施以中药熏蒸联合睑板腺按摩治疗。治疗4周后,观察、记录并比较2组病人眼表疾病指数(OSDI)、泪膜破裂时间(TBUT)、泪液分泌试验(SIT)、角膜荧光素染色(CFS)以及睑板腺功能的变化。 结果观察组OSDI分值、睑板腺功能异常评分、CFS积分均低于对照组,TBUT和SIT值均高于对照组(P < 0.01)。2组疗效差异有统计学意义(P < 0.01)。 结论中药熏蒸联合局部按摩可提高MGD治疗的临床疗效。 Abstract:ObjectiveTo evaluate the clinical effectiveness of herbal fumigation combined with local massage in the treatment of meibomian gland dysfunction(MGD). MethodsOne hundred and thirty-two eyes(66 patients) with MGD were randomly divided into the observation group and control group(66 eyes in 33 patients each group).The control group was treated with artificial tear and antibiotic eye drops, and the patients suspected by infection or grade 3 or above MGD were additionally treated with azithromycin by oral.The observation group was treated with herbal fumigation combined with meibomian gland massage based on the artificial tear and antibiotic eye drops.After 4 weeks of treatment, the ocular surface disease index(OSDI), tear film breakup time(TBUT), Schirmer I test(SIT), corneal fluorescein staining(CFS), and meibomian gland function were observed and analyzed in two groups. ResultsThe scores of OSDI, MGD and CFS in observation group were lower than those in control group, and the scores of TBUT and SIT in observation group were higher than those in control group(P < 0.01).The difference of the clinical effectiveness between two groups was statistically significant(P < 0.01). ConclusionsThe herbal fumigation combined with local massage can improve the curative effect of MGD treatment. -
Key words:
- meibomian gland dysfunction /
- herbal fumigation /
- massage
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表 1 2组各项评估指标的比较(x±s)
分组 n OSDI分值 睑板腺功能异常评分 TBUT值/s SIT值/(mm/5 min) CFS积分值 治疗前 观察组 33 48.59±10.45 3.31±0.44 2.72±0.81 2.62±0.74 9.04±1.62 对照组 33 47.89±11.24 3.22±0.39 2.87±0.91 2.79±0.82 8.86±1.57 t — 0.26 0.88 0.71 0.88 0.46 P — >0.05 >0.05 >0.05 >0.05 >0.05 治疗4周后 观察组 33 15.38±3.78 1.14±0.79 8.26±1.09 6.78±1.42 2.34±0.87 对照组 33 25.68±7.14 2.64±0.86 4.73±1.44 3.86±1.03 4.65±1.12 t — 7.32* 7.38 11.23 9.56 0.36 P — <0.01 <0.01 <0.01 <0.01 <0.01 *示t′检验 表 2 治疗4周后2组临床疗效比较
分组 n 显效 有效 无效 总有效 有效率/% uc P 观察组 33 14 16 3 30 90.9 2.66 < 0.01 对照组 33 8 11 14 19 57.6 合计 66 22 27 17 49 74.2 -
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